MEDICARE: HEALTH CARE INTEGRATED SCHOOL BASED SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1093108185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH CARE INTEGRATED SCHOOL BASED SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 92619
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90809-2619
Country	:	US
Telephone Number	:	888-417-5163
Fax Number	:	888-316-1604

Provider Business Practice Location Address
First Line	:	2600 N CENTRAL AVE
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90222-1640
Country	:	US
Telephone Number	:	888-417-5163
Fax Number	:	888-316-1604

Authorized Official
Title or Position	:	BUSINESS ADMINISTRATOR
Name	:	DWAYNE THOMPSON
Credential	:
Telephone Number	:	888-417-5163

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	03/12/2015

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